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USC researchers propose a quick fix to America’s opioid epidemic

USC researchers propose a quick fix to America’s opioid epidemic

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The overdose epidemic in America is a complex issue that kills 100,000 people annually and reverses progress in life expectancy. However, researchers at the University of Southern California have discovered that an inexpensive intervention, a letter of notification to providers of their patient’s overdose death, can make a difference.

A study led by researchers at the USC Sol Price School of Public Policy and the USC Leonard D. Schaeffer Center for Health Policy & Economics shows that notifying physicians when their patients have a fatal overdose has a long-lasting impact on reducing has opioid prescriptions.

There are no easy solutions to America’s deadly drug overdose epidemic, which kills 100,000 people each year and reverses gains in life expectancy. However, a team of researchers from the University of Southern California (USC) found that one inexpensive intervention can make a difference: a letter notifying providers that their patient has died of an overdose.

A 2018 study by the team found that notifying doctors through an informational letter from their county coroner that a patient had suffered a fatal overdose reduced the number of opioid prescriptions they wrote over the next three months. The team’s new study, published today (January 6, 2023) in JAMA Network Open, shows that these notifications have a lasting impact up to a year later.

“Clinicians don’t necessarily know that a patient they’ve prescribed opioids for has fatally overdosed,” said lead author Jason Doctor, chair of the Division of Health Policy and Management at USC’s Sol Price School of Public Policy and co-director of the Behavioral Sciences program at the USC Schaeffer Center for Health Policy & Economics. “We knew that closing this information loop would immediately reduce opioid prescriptions. Our latest study shows that the change in prescribing behavior appears to be continuing.”

A simple public health intervention with a lasting impact

The doctor and his team sent letters to 809 clinicians — mostly doctors — who had prescribed opioids to 166 people who had suffered fatal overdoses in San Diego County. The letter should be informative and respectful while providing information about a safer prescription. The researchers compared prescribing patterns among these doctors to those who did not receive the letter.

While opioid prescriptions gradually declined across the board, the study authors found that the rate of reduction was faster and more robust among the letter’s recipients. After a year, those who had received the letter were writing 7% fewer prescriptions than doctors who had not received the notification.

“The new study shows that this change is not just a temporary outlier and clinicians then reverted to their previous prescription,” Doctor said. “This inexpensive intervention has a long-lasting impact.”

The doctor acknowledged that attention to the number of deaths from doctor-prescribed drugs has been eclipsed by the focus on rising deaths from illicit opioid use, particularly during the COVID-19 pandemic.

“The sad truth is that we never addressed the first issue of prescription opioid deaths. In fact, it’s all mixed up because, nationwide, about half of the people who die from an illegal drug overdose of fentanyl also had an opioid prescription in the past year,” he explained.

Coroners are uniquely positioned to mitigate future opioid overdose deaths

The big benefit, Doctor said, is that the coroner’s letters provide a unique opportunity to connect with doctors after overdose deaths to save lives from legal and illegal opioid use.

“The letter is a nudge to providers that the opioid epidemic is in their community and affecting their patients. It’s easy to read the headlines and assume you’re not part of the problem,” Doctor said. “Physicians have an opportunity to talk to their patients and consider alternatives to opioids. I believe we can reach about half of the people affected by the illegal fentanyl epidemic through a doctor who has seen them.”

Physicians and other study authors are currently working with Los Angeles County to learn lessons from the research and to review potential public policy interference, including ordering such notifications from county coroners to clinicians.

Reference: “Impact of Prescriber Notifications of Patient Fatal Overdose on Opioid Prescribing at 4 to 12 Months” January 6, 2023, JAMA Network Open.
DOI: 10.1001/jamanetworkopen.2022.49877

Additional study authors include Emily Stewart and Tara Knight of the USC Schaeffer Center; Roneet Lev of Scripps Mercy Hospital San Diego; Jonathan Lucas of the Los Angeles County Department of Medical Examiner-Coroner; Andy Nguyen of Global Blood Therapeutics, South San Francisco; and Michael Menchine of the Department of Emergency Medicine at UCLA. The work was supported by the California Health Care Foundation (grant 19413) to Doctor, Stewart and Knight; the National Institute on Aging (NIA) at the National Institutes of Health (grant R21-AG057395-01 and R33-AG057395 to Knight); National Institute on Substance Abuse (R01 DA046226) and the NIA Roybal Center for Behavioral Interventions (P30AG024968 to Knight).

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